Meta-analysis
Systematic Review and Meta-analysis: Prevalence of Posttraumatic Stress Disorder in Trauma-Exposed Preschool-Aged Children

https://doi.org/10.1016/j.jaac.2021.05.026Get rights and content
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Objective

Trauma exposure is common in preschool-aged children. Understanding the psychological impact of such exposure and the prevalence of posttraumatic stress disorder (PTSD) in this population is important for provision of appropriate and timely intervention. This pre-registered (PROSPERO: CRD41019133984) systematic review and meta-analysis examined the prevalence of PTSD in trauma-exposed preschool-aged children.

Method

Literature searches were conducted of PubMed (Medline), PsycINFO and PILOTS, alongside reference lists of relevant reviews. Studies were selected if they comprised trauma-exposed samples with a mean age of less than 6.5 years, and PTSD was assessed using standardized interviews at least 1-month post trauma. Information on sample characteristics, trauma exposure, PTSD measurement, and diagnostic criteria were extracted. For studies that applied more than one PTSD diagnostic algorithm, the most age-appropriate criteria were used to estimate pooled prevalence estimate across studies. A random-effects model was used for meta-analysis.

Results

Eighteen studies were included (N = 1941). The pooled PTSD prevalence was 21.5% (95% CI = 13.8%-30.4%) when using the most developmentally appropriate diagnostic algorithm that was available. When focusing on the subset of studies that reported both standard adult criteria and age-appropriate criteria (k = 12), a pooled estimate of 4.9% (95% CI = 2.5%-8.0%) was obtained for standard adult criteria (DSM-IV), and 19.9% (95% CI = 12.1%-29.0%) was obtained for age-appropriate criteria (PTSD-AA). Prevalence was 3-fold higher following interpersonal and repeated trauma exposure, compared to non-interpersonal or single-event trauma, respectively. Higher prevalence was found when age-appropriate diagnostic tools were used. There was significant heterogeneity across studies and a lack of studies conducted in low-income countries and applying age-appropriate diagnostic algorithms.

Conclusion

Preschool-aged children are vulnerable to developing PTSD following trauma exposure. Younger children show prevalence trends similar to those of older youths and adults following different types of trauma. Age-appropriate diagnostic criteria are essential to ensure that appropriate identification and early support are provided.

Key words

PTSD
trauma
preschool
children

Cited by (0)

Prof. Dalgleish was funded by the UK Medical Research Council (Grant Reference: SUAG/043 G101400) and by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0211-24045). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

This work has been prospectively registered: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019133984.

Author Contributions Dr. Woolgar contributed to the concept and design of this meta-analysis and performed the literature search, data analysis, interpretation, and write-up. Ms. Garfield conducted an independent data and quality check on the included studies, contributed to the acquisition of data, and write-up. Prof. Dalgleish assisted with the analysis and interpretation of the data and write up. Prof. Meiser-Stedman contributed to the concept of this meta-analysis and assisted with the literature search, data analysis, interpretation, and write-up. All authors contributed to drafting and revising the article and approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Disclosure: Prof. Dalgleish has reported holding grants from the UK Medical Research Council (MR/P017355/1, MC_PC_17213), Wellcome Trust (107496/Z/15/Z), and the Economic and Social Research Council (ES/R010781/1), not directly related to the current study. Dr. Woolgar, Prof. Meiser-Stedman, and Ms. Garfield have reported no biomedical financial interests or potential conflicts of interest.